Ireland's cancer rates are likely to move from being among the worst to the best internationally, according to experts, writes GENEVIEVE CARBERY
IN THE next decade Ireland's cancer survival rates could move from being among the worst to being among the best, a health forum has been told. The Leading Killer by 2020? Cancer in Irelandwas the title of the latest in the series of Pfizer/Irish Times health debates, which took place at the Royal College of Physicians in Dublin last week.
It was chaired by Irish Timesassistant editor Fintan O'Toole. The panellists were Dr Dominic O'Brannagain, consultant in palliative medicine, Our Lady of Lourdes Hospital, John McCormack, chief executive of the Irish Cancer Society, Noelle Duddy, spokeswoman for Co-operating for Cancer Care North West, and Malcolm Kell, a consultant surgeon in the Mater Misericordiae University Hospital and Breastcheck.
Mortality from cancer in Ireland was higher than in comparable countries because Ireland had started putting a comprehensive cancer control programme in place only in 2006, Mr McCormack said. The strategy would “hopefully bring Ireland’s survival rates up to the best in the world” for the four main cancers.
Mr Kell said that in 10 years’ time, Ireland would see the benefits of having a national breast cancer screening programme and survival rates would be similar to those in Britain and north America.
It would take a decade to see the benefits, but Ireland’s breast cancer infrastructure, access to care and level of treatment was equitable to comparable countries, he said.
The difference in morbidity in Ireland compared to other countries was probably because Ireland was a late converter to the multidisciplinary approach in managing and treating cancers, Dr O’Brannagain said.
Despite international evidence supporting the multidisciplinary approach there had been huge opposition to the cancer control programme, as patients wanted to live as close as possible to cancer care centres.
Much of the aftercare, such as chemotherapy or symptom alleviation, could and should be provided closer to where patients were living, he added. For many lung cancer patients, for whom all that could be done was improve the quality of their lives, treatment should be delivered as close to home as possible.
Extension of cancer care into the community was called for by Susan O’Keeffe, a Labour general election candidate for Sligo-North Leitrim who was in the audience.
She said there was an acceptance in Sligo of the need for multidisciplinary care but the “devil was in the detail”, and there was a lack of local care or cancer nurses for patients. If you had an operation in Galway and had a problem with the wound, you had to go back to Galway to get it treated.
Ms Duddy questioned the geographic equity of the cancer control strategy, while accepting the need for a multidisciplinary approach.
She was concerned that cancer services had been “centralised too much” and that the strategy was “overly cautious” by reducing to eight the number of centres even though the report on cancer services by Prof Niall O’Higgins advocated 13 specialist centres.
People had to travel 300km to Galway for breast service, prostate and lung services and Donegal still did not have Breastcheck, she added.
Many patients who needed palliative radiation treatment did not access it because they would have to travel to Belfast or Dublin, she said.
Mr McCormack said the State was failing people when it came to cancer prevention by collecting hundreds of millions of euro in cigarette tax every year but spending only €2 million on prevention.
“We will never beat cancer in Ireland when we have the best part of a million people smoking,” he said.
The implementation of the cancer strategy had rightly concentrated on treatment, but prevention had been “largely ignored”, he said, adding that it was not easy to get people to change their lifestyles, despite knowledge about the links between cancer and obesity.
Mr O’Brannagain said mainstream medicine placed insufficient emphasis on lifestyle and stress. A study in the US had shown that women in advanced stages of breast cancer who had access to a support group with other patients had much better longevity and quality of life.
Affluence had a huge impact on prevention, early detection and treatment – and determined how well you could deal with cancer, he said.
Early detection was as good as prevention, Mr Kell said. While there were obvious lifestyle risks, there were some forms of breast cancer that people could not do much to prevent.
While there was a lack of evidence for a link between stress and cancer, it must have a role, as the more stressed people were, the worse their immune system function was, he said.
Finally, the panel discussed whether significant progress in treatment could be expected over the next decade.
Dr O’Brannagain said more drugs were being developed which were targeted therapies for specific cancers and these would start to become more mainstream.
Mr McCormack said this was a “golden age in cancer research”.